Autism Family Needs Assessment Form
Help us understand your family's support needs related to autism. Please answer the questions below to the best of your ability.
Your relationship to the person with autism
*
Please Select
Parent
Sibling
Grandparent
Guardian
Other relative
Other (please specify)
Age group of the person with autism
*
0-5 years
6-12 years
13-17 years
18-24 years
25+ years
Which areas do you feel your family needs the most support? (Select all that apply)
*
Education/school support
Communication
Social skills
Daily living skills
Community resources
Behavior support
Other (please specify)
How satisfied are you with the current support your family receives?
*
1
2
3
4
5
Please rate the level of need for support in each area
*
Rows
No Need
Some Need
High Need
Education/school support
1
2
3
Communication
4
5
6
Social skills
7
8
9
Daily living skills
10
11
12
Community resources
13
14
15
Behavior support
16
17
18
How easy is it for your family to access autism-related resources in your community?
*
Very difficult
1
2
3
4
Very easy
5
1 is Very difficult, 5 is Very easy
What are the biggest challenges your family faces related to autism support?
What resources or services would be most helpful for your family?
Is there anything else you would like to share about your family's needs?
Submit
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